Mental health outcomes among urban public transport workers: A systematic literature review

Background: Although abundant evidence suggests that Urban Public Transport (UPT) workers are at high risk of poor mental health, there is no consensus on the exposures that explain these outcomes, nor on the effectiveness of mental health interventions in this occupational group. Objective: This study aims to systematically review the literature on the mental health of UPT workers to assess the effects of occupational exposures and interventions. Method: A systematic review was conducted following the PRISMA guidelines. The literature search was performed from 1990 to December 2021 in three databases (PubMed, Scopus, and the Web of Science). The included observational, experimental, intervention and qualitative studies were critically appraised and assessed for risk of bias. A narrative evidence synthesis was conducted by mental health outcomes, occupational exposures, and intervention categories. Results: The database search yielded 1383 records. A total of 83 studies (49 cross-sectional, 8 longitudinal, 8 experiments, 7 interventions, and 11 qualitative) met the inclusion criteria. Bus drivers were the most studied population, followed by metro and train drivers. The included studies covered eleven mental health outcomes: sleep problems, fatigue and recovery needs, alcohol and substance use, PTSD, panic disorders, depression, anxiety, psychopathology symptoms, psychosomatic symptoms, and psychological stress. Work organization-related stressors (work content, workload and pace, working hours, participation and control, career development, status and salary, role in the organization, and interpersonal relationships) and occupational safety risks are the main predictors of negative mental health outcomes. Most intervention studies focus on the management of PTSD symptoms of UPT workers exposed to safety hazards. Conclusion: The results of this review contribute to the consensus on the antecedents of negative mental health outcomes among UPT workers, as well as to the identification of intervention targets and promising research lines for the development of this study field.